Portal venous thrombosis: percutaneous therapy and outcome.
OBJECTIVE
To study the efficacy of percutaneous treatment for portal vein thrombosis (PVT).


METHODS
Of 20 patients who were evaluated for symptomatic portal occlusion, 14 were successfully treated with use of percutaneous techniques. In patients with noncavernomatous PVT (n = 15), the initial treatment was to increase portal output by creating a transjugular intrahepatic portosystemic shunt (TIPS), which was successful in 12 cases. Methods to decrease arterial input to the portal system (hepatosplenic arterial embolization) were used as primary therapy in two patients and in an additional two patients with continued symptoms, despite a functioning TIPS.


RESULTS
All TIPS survivors had patent shunts, although patients with complete PVT required more frequent revisions compared to patients with nonocclusive PVT. Hepatosplenic arterial embolization controlled symptoms in the four patients who were treated, but both patients with patent TIPS died of liver failure after embolization. Of the 14 patients treated, eight died at a mean of 6.2 months (six from hepatoma).


CONCLUSIONS
TIPS is effective in patients with noncavernomatous PVT, although patients with complete thrombosis experience recurrent shunt occlusions and also may develop hepatoma. If TIPS fails, or if symptoms recur, hepatosplenic arterial embolization may be an option.
Walser
E M
EM
Department of Radiology, The University of Texas Medical Branch, Galveston, USA.
NcNees
S W
SW
DeLa Pena
O
O
Crow
W N
WN
Morgan
R A
RA
Soloway
R
R
Broughan
T
T
D000328:Adult; D000368:Aged; D000792:Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D008099:Liver / Q000098:blood supply; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods; D012189:Retrospective Studies; D013924:Thrombophlebitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color